Assessing end-of-life care in cardiology wards within an Australian public hospital: a retrospective medical record audit

Abstract Background Dynamic and fast-paced hospital settings, such as cardiology and cardiothoracic wards, sometimes face challenges in delivery high-quality end-of-life care due to their complexity and constant change. High patient volumes, the emergent and urgent nature of cardiac conditions, variable disease progression and time pressures create often competing clinical demands. As a result, delayed goals of care discussions and poorly managed end-of-life care practices can lead to multilevel, unintended consequences. This study explored end-of-life care practices in cardiology wards using the Australian Commission on Safety and Quality in Health Care (ACSQHC) standardised End-of-Life Care Audit Tool. Purpose The aim of this study was to examine end-of-life care provided to patients who died on cardiology wards within a single Australian hospital, comparing patterns of adherence to and deviations from practices recommended by the Australian National Safety and Quality in Health Service standards. Methods A retrospective medical record audit was conducted on 50 adult inpatients who died on cardiology wards at a single Australian hospital between 2023 to 2024. Descriptive statistics were used to summarise patient characteristics, with means and standard deviations, medians and interquartile ranges, and categorical data presented as frequencies and percentages. Results The median age of patients at death was 69 years (25th-75th percentile: 58-82 years), with 36% being female. The median time between documentation indicating the patient was dying and the time of death was 23.67 hours (25th-75th percentile: 5.79-47.75 hours). At the time of death, 86% of patients had a documented resuscitation plan, 0% had an Advanced Care Directive recorded for this admission. Additionally, 80% of patients identified as dying more than 48 hours prior to death received active interventions and/or investigations in the last two days of life. Conclusions Delayed recognition of dying may subject patients to unwarranted interventions and prevent the timely provision of quality end-of-life or palliative care. To achieve greater alignment to the end-of-life care practices recommended by the Australian National Safety and Quality in Health Service standards, targeted quality improvement initiatives aimed at improving end-of-life care and clinical communication are needed.